NPIMap

Organization Active NPI

Pearl Eyecare Center P S

Doing business as Puyallup Vision Source

  • Optometrist
  • Puyallup, WA
National Provider Identifier
1174294870
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PEARL EYECARE CENTER P S
Doing business as
Puyallup Vision Source
Puyallup Vision Source PS
Practice address
113 W Pioneer
Puyallup, WA 98371-5373
Phone
(253) 845-8215
Fax
(253) 845-7030
NPI assigned
Sep 22, 2021
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEARL EYECARE CENTER P SAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael David Noble, ODNPI 1689090102
Title
Doctor/Owner
Phone
(253) 472-1188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

113 W Pioneer
Puyallup, WA 98371-5373

Mailing address

5016 Bridgeport Way W
University Place, WA 98467-2039
Phone (235) 472-1188

Other practice location 1

5016 Bridgeport Way W
University Place, WA 98467-2039
Phone (253) 342-1738

Other names 2

  • Puyallup Vision Source Doing business as
  • Puyallup Vision Source PS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726001371 WA Part B Supplier - Clinic/Group Practice 4587634829 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Puyallup, WA; Tukwila, WA; University Place, WA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Heil Company PS Dba Pea3 organizations share this tax ID, including this one
Part of
Heil Company PS Dba Pea

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1174294870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5016 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984672039",
            "telephone_number": "235-472-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W PIONEER",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983715373",
            "telephone_number": "253-845-8215",
            "fax_number": "253-845-7030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5016 Bridgeport Way W",
            "address_purpose": "LOCATION",
            "city": "University Place",
            "state": "WA",
            "postal_code": "984672039",
            "country_code": "US",
            "telephone_number": "253-342-1738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEARL EYECARE CENTER P S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEARL EYECARE CENTER P S",
        "enumeration_date": "2021-09-22",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "253-472-1188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puyallup Vision Source",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Puyallup Vision Source PS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Puyallup Vision Source PS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.